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Darnell v. Berryhill

United States District Court, D. South Dakota, Western Division

March 13, 2018

VALERIE A. DARNELL, Plaintiff,
v.
NANCY A. BERRYHILL, ACTING COMMISSIONER OF SOCIAL SECURITY; Defendant.

          MEMORANDUM OPINION AND ORDER

          VERONICA L. DUFFY, UNITED STATES MAGISTRATE JUDGE

         Table of Contents

         INTRODUCTION .............................................................................................. 1

         FACTS ............................................................................................................ 2

         A. Statement of the Case .......................................................................... 2

         B. Procedural History ............................................................................... 2

         C. Background ......................................................................................... 5

         D. Medical Evidence - Chronological ........................................................ 6

         E. Claimant and Lay Witness Statements ............................................... 29

         1. Valerie Darnell's Testimony ............................................................. 29

         2. David Darnell's Testimony .............................................................. 34

         F. Opinion Evidence .............................................................................. 35

         1. Dr. McGee ...................................................................................... 35

         2. Dr. Stacy ........................................................................................ 35

         3. Dr. Doxsee ...................................................................................... 37

         4. Dr. Hamlyn ..................................................................................... 38

         5. Dr. Bentham ................................................................................... 40

         G. The Hearings ..................................................................................... 41

         1. The First Hearing ............................................................................ 41

         2. The Second Hearing ........................................................................ 42

         H. Issues Before this Court .................................................................... 47

         DISCUSSION ................................................................................................ 47

         A. Standard of Review. . .......................................................................... 47

         B. The Disability Determination and the Eight-Step Procedure. . ............. 49

         C. Burden of Proof. . ............................................................................... 50

         1. Burdens Under the Eight-Step Procedure ........................................ 50

         2. Presumption When Commissioner Seeks to Terminate Benefits ....... 51

         3. Substance Abuse Issues ................................................................. 53

         D. Was the ALJ's Decision Supported by Substantial Evidence Given the Nature of Ms. Darnell's Mental Impairments? .............................. 53

         1. Summary of the Medical Evidence .................................................. 56

         2. Summary of the ALJ's Treatment of the Medical Evidence ............... 60

         3. Analysis of the ALJ's Treatment of Medical Evidence ....................... 61

         E. Did the Opinions of Dr. Pelc and Dr. Bentham Support the ALJ's Decision? .......................................................... 73

         1. Does a Medical Expert Have to Consider Evidence Other than Medical Evidence in Completing a PRTF or Formulating Mental RFC? ................................................................................... 75

         2. Did the ALJ Rely Solely on Dr. Pelc's Opinion at Steps 4 & 5? ......... 82

         F. Was a Finding of Disability Required Based on the ALJ's Evaluation of Dr. Hamlyn's Opinion? .......................... 84

         G. Type of Remand ................................................................................. 90

         CONCLUSION ............................................................................................... 92

         INTRODUCTION

         Plaintiff, Valerie Darnell, has filed a complaint seeking judicial review of the Commissioner's final decision denying her disability insurance benefits under Title II of the Social Security Act for the period from September 1, 2010, through October 24, 2011.[1] Ms. Darnell was previously found to be disabled as of September 1, 2004, and awarded benefits. Following the 14-month hiatus from September, 2010, to October, 2011, Ms. Darnell was again found to be disabled (as of October 25, 2011) and awarded benefits. Thus, this administrative appeal concerns only Ms. Darnell's entitlement to disability benefits during this 14-month middle interlude.

         Ms. Darnell now moves the court for an order reversing the Commissioner's final decision and remanding with direction to award benefits. See Docket No. 12. Nancy Berryhill, the Acting Commissioner of Social Security (“Commissioner”) urges the court to affirm her decision below.

         This appeal of the Commissioner's final decision denying benefits is properly before the district court pursuant to 42 U.S.C. § 405(g). This matter is before this magistrate judge pursuant to the consent of both parties in accordance with 28 U.S.C. § 636(c). Based on the facts, law and analysis discussed in further detail below, the court reverses, remands and instructs that benefits be awarded for the period from September 1, 2010, to October 24, 2011.

         FACTS[2]

         A. Statement of the Case

         This is a request for review of a decision terminating benefits, and charging an overpayment. The ALJ partially revised the termination, finding that Ms. Darnell was not disabled from September 1, 2010 through October 24, 2011 - the relevant period. This resulted in Ms. Darnell being obligated for an overpayment for that period.

         B. Procedural History

         In 2005 Darnell applied for social security disability in Missouri. AR602, Ex. 5F/2. On July 21, 2005, a state agency found Darnell disabled as of September 1, 2004. AR65. On December 12, 2010, DDS found that disability had ceased on September 1, 2010. AR64.

         Darnell requested that benefits continue until an ALJ could decide the case. AR478, Ex. 5E/1. Because the first decision was unfavorable, and the second decision was adverse for the period from September 1, 2010 through October 24, 2011, she incurred an overpayment and was liable to repay benefits received for a 14-month period. AR478, Ex. 5E/1, ¶ 2. The amount of overpayment is not shown in the record.

         The first ALJ's decision, dated October 18, 2012, noted the eight-step evaluation process for termination of benefits. AR53. ALJ James Olson found that on July 21, 2005, the "comparison point decision" (CPD), Darnell had bipolar disorder, panic disorder with agoraphobia, and history of substance abuse and alcohol abuse, that prevented completion of a normal work week. AR54. She still had these impairments. AR54. She did not meet a listing based on the opinion of Robert Pelc, Ph.D., that restrictions were mild to moderate. AR55.

         Therefore, medical severity had decreased, and medical improvement had occurred as of September 1, 2010. AR55.

         Darnell retained present counsel (AR108) on November 8, 2012. Not found in the record are: the request for Appeals Council review and multiple requests to access the electronic hearing record.

         On July 2013, Darnell's counsel submitted Darnell's statement supplementing her testimony (AR149-56), Dr. Hamlyn's medical source statement dated December 14, 2012 (AR158-61), and a brief (AR163-85). On August 8, 2013, she submitted Dr. Hamlyn's reports from August 10, 2012 to May 10, 2013. AR186.

         On August 27, 2013, the Appeals Council remanded the case to weigh Dr. Hamlyn's opinion, properly weigh David Darnell's statement that the first ALJ had improperly weighed, and reconsider the first ALJ's flawed credibility assessment. AR105-07.

         On August 12, 2014, Darnell had a hearing before Stanley R. Hogg, ALJ. AR985. Present and testifying were Valerie Darnell, represented by Attorney Catherine Ratliff; Jack Bentham, medical expert, and William Tysdal, vocational expert. AR987. Dr. Bentham opined that Darnell met disability criteria on and after October 25, 2011, but not from September 2010 to October 24, 2011, owing to absence of evidence for this period.

         Counsel asked the ALJ to hold the record open for psychiatric evidence that she intended to submit. AR540, Ex. 18E/2. The ALJ's assistant called to inform counsel that it would not be necessary to submit this evidence because the ALJ was issuing a fully favorable decision. Id.

         On September 4, 2014, ALJ Hogg issued a decision affirming the cessation of disability from September 1, 2010 to October 24, 2011, and finding that Darnell became disabled again on October 25, 2011. AR48.

         Darnell requested Appeals Council review of the September 1, 2010, to October 24, 2011 period and submitted evidence from Darnell's family doctor dated November 2010 to September 2011, Two Rivers Psychiatric Hospital admission in June 2011, and her psychiatrist's July 2011 medical management note. AR538, Ex. 19E/1.

         The Appeals Council declined review on August 24, 2016. AR5-9.

         C. Background

         Valerie Darnell was born in 1972, in Georgia, the youngest of three. AR857, Ex. 21F/17. She had panic attacks and hallucinations as a child, according to her treating psychiatrist's report of initial interview in October 2011. AR856, Ex. 21F/16; also at ¶ 509, Ex. 11E ("I have always had the disorder even when I was younger"). By age 13 she had started to self-medicate with drugs and alcohol. AR856, Ex. 21F/16. She stated, "That took away some of the symptoms, hearing and seeing things that weren't there...." AR155. She reported sexual abuse by a cousin from age 8 to 11 and being raped at 13. AR857, Ex. 21F/17. At age 16 she attempted suicide and was psychiatrically hospitalized. AR604, Ex. 5F/4. She dropped out of 11th grade and later earned a GED. AR603, Ex. 5F/3. She reported that she finished beauty school but did not get a cosmetology license. Id. In her 20's, she worked in a day care center and appliance sales. Id. "Back when I worked, I had the same symptoms; I self-medicated with alcohol and drugs, I don't know how I worked. Drinking helped calm the voices and flashes; how I interacted with other people I don't know." AR156. At age 21 she was using polysubstances and was in a chemical dependency treatment program. AR604, Ex. 5F/4; AR848, Ex. 21F/8.

         She married David in 1994. AR603, 5F/3. Her husband owns his own roofing company. AR848, Ex. 21F/8. They have five children.

         In October 2011, the family moved from Warrensburg, Missouri to Rapid City. AR64, 1010. Darnell engages in limited activities and the children are self-sufficient. David works near home, his schedule is flexible, and he is supportive. AR151, 911, Ex. 24F/3.

         D. Medical Evidence - Chronological

         On October 1, 2004, Darnell saw Cindy Chu, MD[3], at SSM Health[4] clinic in Wentzville, Missouri. AR590, Ex. 4F/2. She complained of severe depression, hallucinations, and anxiety. Id. She could feel her moods surging more. She had a history of drug overdose and was status post rehab. She had recently moved from Colorado. About a year ago she re-started drinking and using illicit drugs. Id. She stopped completely when pregnant. She had no health insurance. Dr. Moore diagnosed panic attack, depression/anxiety. He increased Effexor[5], continued Ambien, [6] and started Risperdal.[7] Id. She was to return in one month. Id.

         On October 12, 2004, Darnell returned to the clinic and saw John Moore, M.D. AR591, Ex. 4F/3. She complained that her depression was getting worse even after Dr. Chu increased Effexor. "Risperdal not helping for hallucinations (sees insects, sees people trying to steal things in the house). She complained of panic attacks. Dr. Moore kept Effexor at 150 mg. and increased Risperdal to 2 mg. a day, adding Buspar 15 mg. for anxiety. Id.

         On October 22, 2004, Darnell returned to the clinic complaining of severe depression, waking at night and being unable to go back to sleep and continuing to hear voices. The increased dose of Risperdal was not helping. AR592, Ex. 4F/4. Dr. Moore diagnosed depression with anxiety, some psychotic features. He stopped Risperdal and started Zyprexa[8] 5 mg. Id.

         On October 29, 2004, Darnell told Dr. Moore the hallucinations had decreased and she still had trouble with sleep. Her anxiety was somewhat less. Dr. Moore decided to hold off on Wellbutrin[9] for now. He noted that an increase of Effexor might help but he would wait as she was pregnant. AR593, Ex. 4F/5.

         On November 18, 2004, Darnell saw a therapist, J. Milhaus, BC, FNP, upon referral from Dr. Moore. AR594-96.

For past 6 mos has had positive sxs. Had tried Risperdal [and had increased] hallucinations. Hears people whispering. Sees “something” come up behind her, sees hands coming out of holes in walls, or someone trying to steal TV. Has a mixture of highs & lows.... [Husband] never knew of hallucinations - he thought mood swings were due to alcohol & drugs. They have separated twice in 3 yrs.... In 1999 had prozac x 2 m - it didn' work.... Zoloft didn't work.... Hallucinations & voices have slowed down since starting meds. Is now sleeping better. No anxiety attacks x 2-3 weeks. Believes medications are helping. [Husband] also states they are helping - he additionally voiced concerns about continuing marriage due to these problems & especially past problems w/ alcohol & drugs.... MS - Alert, coherent, flat affect. Imp: psychosis NOS, Schizophrenia Provisional. Plan - increase Zyprexa to 10mg.

AR596, Ex. 4F/6.

         On December 2, 2004, Darnell told her therapist that she was about the same. AR598, Ex. 4F/10.

Sometimes voices in her head try to turn her against [husband] -"like he's the enemy but he's not!" Hears voices more often when he's home - she takes things negative, like a verbal attack - but she knows it's not. Voices are also present at other times.... Still occasionally sees things - shadows, or see ants at the coffee pot -covered holes in walls, no longer sees hands coming through walls. Has rearranged furniture so she doesn't feel that people are coming up behind her.

         Darnell told her therapist that she had been sexually abused for three months at age nine. "No one else knows about that." Anxiety had been bad and she woke at night in a panic. "Husband tells her she's not breathing & he waits for her to start breathing again." She was taking Ambien. She had a flat affect. J. Milhaus planned to increase Zyprexa and Buspar. AR597-98, Ex. 45F/9-10.

         On February 10, 2005, J. Milhaus stated that Darnell had a baby in January and now had five children. AR597, Ex. 4F/9. She continued on Effexor, Buspar and Zyprexa. "Visual, auditory halluc. very disturbing, worse when [pregnant?] - happened when younger, going back to 7-8 y/o - plus lots of panic sxs. She had turned to drugs and alcohol and left school in eleventh grade because she "lost interest in everything." Id. On her father's side there was "lots of alcohol" and a cousin had committed suicide at age 19. Id. She said she was taking care of the baby okay and had some difficulty caring for the other kids. AR599, Ex. 4F/11. The therapist observed depressive affect. Her impression was "Bipolar I" and she added Lamictal[10] to the medication regimen. Id.

         The nurse-practitioner-therapist adjusted medications two more times that month. AR599, Ex. 4F/11.

         On March 8, 2005, Darnell told J. Milhaus that her anxiety was still bothering her, her heart rate was increased, her hands shook, she had loss of appetite and short temper during anxiety. AR600, 4F/12. Her husband was home more, helping. Darnell said she was more depressed, her hallucinations were decreased but sometimes increased with anxiety, and she had experienced "4 panic attacks" since her last visit. Ativan helped initially. The therapist reported flat affect. Her impression continued to be "Bipolar." She increased Lamictal to 100 mg. Id.

         On March 10, 2005, the therapist recommended a sleep study and referred Darnell to Dr. Breschetto at SJMH, Washington, Missouri. AR600, 4F/12.

         In June 2005, the Missouri state agency sent Darnell for a psychological consultative examination with Michael Armour, Ph.D. AR602, Ex. 5F/2. At this time she was on psychotropic medications prescribed by Dr. Chu and Dr. Crane[11], her treating psychiatrist: Ambien, Oxazepam, Zyprexa, Effexor, Lamictal, and Buspar. AR604, Ex. 5F/4.

         When Darnell saw Dr. Armous she described panic attacks two to three times a week when her heart raced, she broke out in a sweat, had tremors and shortness of breath, and urinated on herself. AR604, Ex. 5F/4. After a panic attack she was "jittery." AR605, Ex. 5F/5. She would call her husband to come home. Id. At times she stayed home out of fear of having a panic attack. Id.

         When her mood was "down, " Darnell related, she did not talk to others, isolated, had crying spells and no energy, and neglected her hygiene. When her mood was up she talked "real fast, " jumped from topic to topic, had increased energy and could go without sleep for two days. AR604, Ex. 5F/4. She stated that her concentration was poor regardless of whether her mood was up or down. Id. On this day her mood was "in the middle." Id.

         Darnell told Dr. Armour "that her panic attacks, ongoing anxiety, and not feeling safe all contribute to her not being able to work." AR605, Ex. 5F/5. She denied "first rank symptoms" of psychotic thought disorder. Id.

         Dr. Armour reported his mental status examination:

She was cooperative with the evaluation and responded to the questions in an appropriate manner. Her speech was of a normal rate, rhythm, and volume. She did not display signs of loose associations, tangential thinking, or circumstantial thinking. Her speech overall was organized and her responses were relevant and coherent. Her mood was subdued. Her affect was limited in terms of range in that she did not show much emotional variation, but the emotion she did express was appropriate to the emotional tone of the subject matter. When asked about first rank symptoms indicative of an ongoing psychotic thought disorder, Ms. Darnell denied experiencing audible thoughts, thought broadcasting, thought insertion or withdrawal, or thought control. When asked about auditory or visual hallucinations, she stated that she hears children calling her name. She stated that she sees things "over her shoulder" and this occurs at night. One to two times per month she sees people "moving in the room." She stated that she has concerns that others are out to harm her but vague in providing details about beliefs. She did not present this concern as a more systematized delusional belief.

AR605, Ex. 5F/5.

         Darnell reported that her sleep pattern was variable. Id. Dr. Armour estimated that her intellect was low-average to average. AR606, Ex. 5F/9. Her immediate memory appeared intact. She could recall three out of three objects immediately, two out of three after five minutes, and long-term memory appeared intact based on her ability to report her history. Id. Dr. Armour assessed insight and judgment as impaired at times by her depressive symptoms. Id.

         Dr. Armour diagnosed bipolar one disorder with psychotic features; panic disorder with agoraphobia; alcohol and cocaine abuse, and sexual abuse as a child. GAF 45-50.[12] AR606, Ex. 5F/6.

         Dr. Armour assessed "moderate to at times severe impairment" in social functioning. He assessed "at least moderate impairment" in concentration, persistence or pace "depending upon the fluctuating severity of her mood symptoms." AR607, Ex. 5F/7. He assessed three areas of mental residual functional capacity (MRFC). AR608-09, Ex. 5F/7-8. Ability to understand and recall instructions was mildly to moderately impaired. AR607, Ex. 5F/7. Ability to sustain concentration and persistence was moderately to at times severely impaired. Id. Ability to interact socially and adapt to her environment was severely impaired for these reasons: ongoing problems isolating, interacting only with her family, and beliefs about people being in her residence, and - although she appeared able to care for her residence - she reported fluctuating mood and impaired ability to interact with others, and panic attacks when she would call her husband to come home. AR607-08, Ex. 5F/7-8.

         In 2009-10 Darnell's family physician, Syed Hasan, M.D., treated her anxiety with Xanax, [13] fluctuating moods with Lithium, [14] and psychotic symptoms with Seroquel.[15] AR610-33, Ex. 7F. By January 2010, Dr. Hasan stated that she seemed to be more depressed. "She was feeling much better earlier however seems to be more depressed." Id. She was on four medications for bipolar disorder - Lamictal, Lithium, Seroquel, and Abilify, [16] plus Effexor. AR614, Ex. 7F/5. Dr. Hasan increased her Seroquel dose. Id. He wrote, "She does not want to see a psychiatrist. Will monitor very closely." Id.

         On March 3, 2010, Darnell told Dr. Hasan that her depression and anxiety had markedly improved at this time. AR613, Ex. 7F/4.

         On May 5, 2010, she saw a Kansas City psychiatrist, Michael Everson, MD. AR634-38, Ex. 8F/1. Dr. Everson listed her symptoms: mind racing, sleep disorder, reckless behavior, sexual and drug use, big mood swings, increased spending, panic attacks, lots of anxiety, excessive worry, depressed or sad mood, and irritability. AR634, Ex. 8F/1. Dr. Everson diagnosed bipolar mood disorder, panic disorder, and generalized anxiety disorder, and assigned Darnell a current GAF score of 70. AR638, Ex. 8F/5. Dr. Everson recommended medications: Xanax, Lamictal, Abilify, Seroquel, and Neurontin.[17] AR638, Ex. 8F/5.

         On May 8, 2010, Dr. Hasan said she seemed more sleepy and was "pretty concerned about her medications." AR645, Ex. 9F/7. Dr. Hasan stated that Dr. Everson had recommended counseling and she did not want to do that. She remained anxious. Id.

         On May 18, 2010, Dr. Hasan saw Darnell for chest pain, palpitations and dizziness. AR644, Ex. 9F/6. She had been to the ER for this and continued to have chest pain radiating to her back. Id. She was still "pretty depressed. At times she will be laughing. At times she will be sleeping.... She does not like the medication changes which were done by Dr. Everson." She wanted to go back on her previous medications. Id. Dr. Hasan resumed Lithium and held Neurontin and otherwise continued the medication regimen. Id. Darnell's chest pain was significant enough that from May to July 2010, she was worked up for heart disease and had an abnormal nuclear stress test but normal coronary arteries. AR641-43, 676-78, 680-82; Ex. 9F/3-5, 13F/10-12, 14-15. She did not return to Dr. Everson.

         In August 2010, Dr. Hasan said her depression and anxiety had markedly improved and that her depression was stable. AR673, Ex. 13F/7.

         In November 2010, he said she was feeling better, her mood was stable, and she denied any suicidal ideations, thoughts, or plans, but that she felt very weak, tired, lethargic, and "gets pretty tired, weak and more suicidal." AR671, Ex. 13F/5. He noted, "She cannot even work a few hours. She tried to help her sister-in-law. However, she could not do it." Id. He renewed her Seroquel and Xanax, and added vitamin D 50, 000 units a week for 12 weeks. Id.; AR968, Ex. 30F.

         In January 2011, she had a diagnostic interview by a therapist who recorded symptoms including feeling sad, tired, tearful, worthless, hopeless, with loss of interest, withdrawal from others, difficulty concentrating and making decisions, confusion, racing thoughts, recurring worry, anxiety and irritability. AR798, Ex. 15F/5. She used drugs in a binge pattern. She had been convicted of a felony for assaulting her husband. Id. "Valerie automatically turns to drugs to manage her emotions." AR800, Ex. 15F/7. In interview she was intensely emotional. Id. On mental status she was angry/irritable, depressed, agitated, forgetful, indecisive, had loss of interest and motivations, and woke fatigued. AR801, Ex. 15F/8. GAF was assessed at 35. AR803, Ex. 15F/7.

         On February 9, 2011, Darnell saw Dr. Hasan. "She was more depressed. She has been seeing a counselor. She had separated from her husband for a month. Impressions included depression, anxiety, and bipolar disorder. AR966, Ex. 30F.

         On February 13, 2011, the therapist assessed GAF 35, "severe depressive symptoms." AR800, 803; Ex. 15F/7, 10. The anticipated completion of treatment was April 2011. Id. At her third session, the therapist stated that the client reported feeling confused as to whether she should rent an apartment, and nervous about staying in the family residence; she appeared worried and appeared to be gaining new awareness of the reasons for her behaviors and was learning techniques to manage challenges. GAF was assessed as 45. AR797, Ex. 15F/4.

         On February 16, 2011, Dr. Hasan recorded complaints of occasional weakness, tiredness, fatigue, and dysuria, but better-controlled depression and anxiety. Impressions included bipolar disorder, depression and anxiety. AR969, Ex. 30F.

         On March 10, 2011, Dr. Hasan stated that her mood was "pretty stable at this time." He treated her for a virus and back pain. Impressions included depression, anxiety, bipolar disorder, severe anxiety disorder, insomnia, and hypothyroidism. AR967, Ex. 30F.

         On April 14, 2011, Darnell went to Dr. Hasan with complaints of weakness, tiredness, fatigue, and hot flashes. She had been taking her medications regularly and trying to watch her diet. AR965, Ex. 30F.

         From June 2-9, 2011, Darnell was hospitalized at Two Rivers Hospital, a mental hospital. AR 970, Ex. 31F/1.

         Mohammed Mirza, M.D., attending psychiatrist, reported a psychiatric evaluation on June 2, 2011. AR978-79, Ex. 31F. Darnell told him that she was bipolar, had been using meth for six months, had mood swings, was paranoid, hearing voices and seeing people. She said she was tearful, and that she had a lot of trauma issues. "Everybody is telling me I'm an addict but they don't focus on my abuse. I've had a lot of abuse...." AR978, Ex. 31F. Dr. Mirza noted the psychiatric history. He reported that Darnell had pressured speech, and was somewhat upset and tearful, "so we are not able to get more detailed information, but she is intelligent, motivated, wants to get help." Id.

         Darnell told Dr. Mirza that she had been drinking for six months and recently had been using a quarter ounce to an ounce of meth every two or three days. Dr. Mirza noted the history of childhood physical and sexual abuse. Dr. Mirza recommended inpatient treatment and a program including OT/RT, individual and group therapy in the Dual Diagnosis Program "until we can transfer her to Trauma." AR979, Ex. 31F.

         Jonas Bustos, MD, reported Darnell's admission history and physical on June 3, 2011. AR980, Ex. 31F. She complained of agitation, depression, anxiety, feeling out of control, feeling things crawling in her skin, and auditory and visual hallucinations. She had not taken her medications for five to seven days. She had a history of sexual, physical, and emotional abuse. She had panic episodes, flashbacks, difficulty concentrating, racing thoughts, insomnia, and agitation. She was on daily doses of Lithium 600 mg., Xanax 4 mg., Seroquel 900 mg., Lamictal 400 mg., and Effexor 300 mg. She had been sober from alcohol for a year and smoked a pack a day. Id. Dr. Mirza diagnosed psychosis, rule out bipolar disorder and other non-relevant medical diagnoses. She would be admitted to treat her psychosis.

         Dr. Mirza wrote the discharge summary. AR972-73. Dr. Mirza noted that she had seen a psychiatrist and nurse practitioner in St. Louis and then moved to Warrensburg and saw Dr. Hasan but not a psychiatrist. She had seen Dr. Everson once and did not like him. AR972, Ex. 31F. During this hospitalization, Dr. Mirza discontinued Risperdal and Lithium and added Seroquel, Xanax, Depakote[18] and Effexor. He decreased her Seroquel and Xanax during the hospitalization. Id. In her discharge summary, Dr. Mirza decided that she was "not ready for trauma issues, and needed to get her addiction more stabilized and continue to work on her bipolar disorder.” AR973, Ex. 31F. She would follow up with him (Dr. Mirza) on July 7, 2011, and would follow up with inpatient CD rehab at Turning Point Hospital in Moultrie, Georgia. She was discharged on Xanax, Seroquel, Effexor, Depakote, thyroid supplement and a statin. Discharge diagnoses included bipolar mood disorder, rapid cycling, with psychosis, resolved. GAF was 50 and prognosis was guarded. AR973, Ex. 31F.

         Her discharge papers said she would follow up with Dr. Mohammed Mirza; Pathways of Warrensburg, MO, therapists; and inpatient CD rehab at Turning Point Hospital in Moultrie, GA. AR974, Ex. 3F. Her goals for recovery were: "Stay around family more, spend alone time in room." Id.

         On June 14, 2011, Dr. Hasan saw Darnell for medical reasons (back and hip pain) and noted her recent discharge from Two Rivers Hospital. "She is going to follow with the psychiatrist and counselor. She is going to go to the alcohol and drug rehab program. Multiple centers have been contacted." Impressions included alcohol and drug abuse, depression, anxiety, and bipolar disorder. AR964, Ex. 30F.

         On July 2, 2011, Dr. Mirza saw Darnell in follow-up. "She went to Georgia, learning point." AR983. She was on Depakote, Seroquel, and Geodon.[19] She stated, "I am feeling negative about the program here." She was “less labile some hallucination[s]." Assessment was bipolar [unreadable] psychosis]. The plan was to increase Geodon and add Effexor and Remeron. Id.

         On August 22, 2011, Dr. Hasan saw Darnell for medical treatment and noted that she was "following with her psychiatrist.” AR963, Ex. 30F. In fact, she has an appointment on 9/26/11. She has been taking Geodon 120 mg., Effexor 10 mg., and Risperdal [?] 30 mg. and her mood was "pretty stable." Id.

         On September 9, 2011, Dr. Hasan saw Darnell for the last time. He wrote, "Has been following with the psychiatrist on a regular basis." AR962, Ex. 30F. His impressions on this date, the last time he saw Darnell, were right shoulder pain, bipolar disorder, hypothyroidism, depression, anxiety and history of substance abuse. Id.

         Darnell and her family moved to Rapid City, SD. On October 25, 2011, she was seen at Rapid City Regional Behavior Health by Harry Hamlyn, MD, board-certified psychiatrist[20]. AR856, Ex. 21F/16. Dr. Hamlyn recorded a history of bipolar disorder that Darnell thought had started in her twenties and she gave history of panic attacks and hallucinations in childhood. He recorded her drug and alcohol history since age 13 and that bipolar disorder was diagnosed and she was placed on medications at age 33. AR856, Ex. 21F/16.

         Dr. Hamlyn noted, "She still has some issues with chemical dependency problems, but has been clean completely since June 1, 2011." She still had bipolar symptoms, and reported auditory hallucinations of voices and visual hallucinations and said she could not watch television "because she sees and hears things different than what other people see and hear." AR856, Ex. 21F/16.

         "She has panic attacks occasionally. She does still have some highs and lows in her mood and sometimes has episodes where she wants to isolate herself ... perhaps once or twice a week." In the past she was suicidal but not lately. Darnell told Dr. Hamlyn that sometimes she had mixed episodes with highs and lows together, sometimes manic episodes alone, sometimes depressive episodes alone. "When she has a high, she will have racing thoughts and hyperactivity and rapid speech and impulsivity and then of course when the hallucinations went down, she will have low energy level and poor motivation and suicidal thinking. She tries to keep busy when she is depressed." She felt that her sleep was poor but she was sleeping from 9 p.m. and waking about 4:30 a.m. AR856, Ex. 21F/16.

         Darnell related to Dr. Hamlyn that her energy level during the day was fairly good and her appetite and weight were stable. AR856, Ex. 21F/16. Her concentration was "okay currently, but at times she has difficulty with that when she is in the midst of an episode. She is able to enjoy herself. She relates that she gets along well with her husband." AR856-57, Ex. 21F/16-17.

         Dr. Hamlyn noted the "lots of different medications" that had been tried in the past "including Lithium, Lamictal, Xanax, Seroquel, Risperdal, Zyprexa, Abilify, Geodon, Trazodone, [21] and Ambien. She likes her current medications of Remeron, Effexor and Geodon." AR857, Ex. 21F/17.

         Darnell told Dr. Hamlyn that her last hospitalization was at Two Rivers Psychiatric Hospital in Kansas City, Missouri and that she had been sober and clean since then. AR857, Ex. 21F/17. Dr. Hamlyn noted Darnell's developmental history, education and work history, family history, other medical history (hypothyroidism, GERD, cholecystectomy, five pregnancies and total hysterectomy with bilateral salpingo-oophorectomy), and current living arrangements. Id. He noted her legal history, a domestic violence charge in Colorado, and a DUI in Colorado eight years ago. AR858, Ex. 21F/18.

         Dr. Hamlyn noted Darnell's alcohol and substance abuse history. "At the worst, she was a daily drinker, had blackouts, withdrawal symptoms, and morning drinking. She had used cocaine, methamphetamine, crack cocaine, LSD, and mushrooms. She had not used drugs since June 1, 2011. She did smoke a pack a day and drank up to six cups of coffee daily and two cans of pop. She had never had a problem with gambling. AR858, Ex. 21F/18.

         Dr. Hamlyn reported his mental status exam. Darnell was alert, eye contact was good, motor level was normal, and affect was appropriate to a mildly anxious mood. Speech was normal, associations were logical, stream of thought was unremarkable, and thought content showed no overt delusions.

         She admitted having auditory and visual hallucinations off and on even when her mood was relatively stable. She was oriented to person, place and time; concentration was good; memory was grossly intact; fund of knowledge was good; and insight and judgment were intact. AR858, Ex. 21F/18.

         Initially, Dr. Hamlyn diagnosed bipolar disorder, depressed, in partial remission with psychotic features, and polysubstance and alcohol dependence in remission since June 1, 2011. He noted mild to moderate stressors of just moving from Missouri and worry about a court case involving SSD. He assessed GAF as 60. AR858-59, Ex. 21F/18-19.

         Dr. Hamlyn increased her Geodon to 160 mg. to help mood stabilization, hallucinations and sleep. He increased Remeron to 30 mg. to help sleep and mood stability. He continued the current dose of Effexor 30 mg. AR859, Ex 21F/19.

         In November 2011, Dr. Hamlyn wrote, "She relates that she is feeling much better from the standpoint of her anxiety. She still has the auditory hallucinations of voices but it does not occur often and she is avoiding watching television because that is when it will occur the most." AR860, Ex. 21F/20. He continued the diagnosis and added Wellbutrin to her medication regimen. Id.

         In December 2011, Dr. Hamlyn stopped Wellbutrin and increased Geodon to 240 mg.[22] because:

Ms. Darnell complains of having a lot of anxiety and also racing thoughts and starting to have a visual hallucinations. She sees bugs crawling around the coffee pot. She also is hearing voices and has a difficult time watching television because they are saying different things than what they are supposed to be saying. It is as though she is going back into another episode of her illness. I told her this may be partly a side effect Wellbutrin and she should ...

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